This report of a systematic review of complementary medicine to treat premature ejaculation is fairly complete and includes important limitations of the research.
Some additional context would have been helpful, including information about prescribed treatments that have been approved in other countries, such as SSRI antidepressants, but not in the U.S.
While the problem itself–how exactly one defines “premature” may be open to debate and discussion–it is clear that this is an issue that many men may experience, yet may not want to consult their clinician about. Many may turn to alternative remedies as a result, and this study helps provide some insight into their effectiveness. We were pleased to see that the story made clear that there were limitations to the data, and that the placebo effect could have played a big role.
There were no discussions of cost here, apart from the fact that the products in question would likely be available without a prescription and hence, the costs pertaining to a doctor’s visit would not be relevant here.
While we don’t really know what particular ingredients might be in the tested Chinese herbal treatments, the Ayurvedic herbal medicine or the Korean topical cream, we do learn that “Chinese herbal medicine increased IELT by about two minutes, Ayurvedic herbal medicine increased IELT by nearly a minute and topical cream increased IELT by more than eight minutes.” We would have benefited from knowing what the baseline times were, ie: if the two acupuncture studies were found to increase intravaginal ejaculatory latency time (IELT) by about half a minute compared to placebo, how much additional time did the placebo provide?
The report helpfully mentioned that “some studies, but not all, discussed side effects such as gastrointestinal discomfort, dizziness, mild pain and decreased libido. When they were reported, the adverse effects were generally mild.”
It would have been useful to note that the off-label use of SSRIs also involves some rate of adverse effects and that some foreign-sourced herbal treatments have been found to be adulterated with compounds from prescription drugs, and that quality control of herbal treatments is sometimes a problem.
The report explained this was a systematic review looking at a group of studies. The story noted that there were limitations, such as the “underlying weakness of the studies evaluated,” adding “Bias was unclear in most of the studies, and only five used stopwatches to measure IELT, which is the ‘gold standard’ for premature ejaculation studies.”
We’re also told that “the studies are so different, it’s tough to draw conclusions about the different options. For example, the five Chinese medicine studies tested different substances, including Qilin pills, Yimusake and Uighur.”
Even though the prevalence of premature ejaculation is a subject open to disease-mongering, this report did not veer in that direction, noting how difficult to measure it is. “Some studies suggest that between 20 and 30 percent of men report early ejaculation concerns, but the International Society for Sexual Medicine estimates that about 4 percent of men have a lifelong condition.”
The researchers interviewed don’t appear to have any conflicts of interest, and several independent sources were included.
The study noted that the various alternatives were compared against placebo or alternative treatments. It would have been useful to know how the various herbal remedies compared against what is considered by many physicians to be a reference standard–the off-label use of an SSRI antidepressant, such as paroxetine.
It’s not clear how available these products are. Considering how many products are sold online for this problem, some information on what these products are, and how available they are, would be useful.
The study establishes its novelty right up front, saying it is the first systematic review of the alternatives to treat premature ejaculation. Based on a literature search we conducted, this appears to be accurate.
The range of quoted experts and the comprehensiveness of this story would suggest there isn’t an over-reliance on a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
Comments (1)
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Gary Schwitzer
February 1, 2017 at 10:50 amWe may have been too lenient on our application of the disease-mongering criterion. Our analysis only commented on prevalence statistics, but the bigger concern is whether a condition has been framed as a disease requiring treatment when, in fact, there are important questions about that framing and assumption. Indeed, the marketing of treatments for premature ejaculation has been cited as a prime example of disease-mongering.
Some reading on the topic:
As publisher, I felt compelled to add this perspective to our review. The story could have addressed these concerns with even one sentence, but didn’t. That was the biggest thing that jumped out at me when I read the story.
Gary Schwitzer
Publisher
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